ROUTINE PREOPERATIVE BLOOD GROUP AND SAVE TESTING IS UNNECESSARY FOR ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY
Abstract
Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes.
Keywords: Cholecystolithiasis; laparoscopic cholecystectomy; blood group; blood transfusionReferences
Saxena S, Nelson JM, Osby M, Shah M, Kempf R, Shulman IA. Ensuring Timely Completion of Type and Screen Testing and the Verification of ABO/Rh Status for Elective Surgical Patients. Arch Pathol Lab Med 2007;131(4):576-81.
Czoski-Murray C, Lloyd Jones M, McCabe C, Claxton K, Oluboyede Y, Roberts J, et al. What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature. Health Technol Assess 2012;16(50):1-159.
Routine preoperative tests for elective surgery. Guidance and guidelines, NICE. [Internet]. [cited 2016 May 18]. Available from: https://www.nice.org.uk/guidance/ng45
Ransom SB, McNeeley SG, Hosseini RB. Cost-effectiveness of routine blood type and screen testing before elective laparoscopy. Obstet Gynecol 1995;86(3):346-8.
Parker S, Mahawar K, Balupuri S, Boyle M, Small P. Routine group and save unnecessary for gastric band surgery: a retrospective case review audit of 1018 bariatric patients. Clin Obes 2012;2(2-3):73-7.
Hildebrand DR, Binnie NR, Aly EH. Is routine blood cross-matching necessary in elective laparoscopic colorectal surgery? Int J Surg 2012;10(2):92-5.
Kaushik R. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg 2010;6(3):59-65.
Huang X, Feng Y, Huang Z. Complications of laparoscopic cholecystectomy in China: an analysis of 39,238 cases. Chin Med J (Engl) 1997;110(9):704-6.
Schäfer M, Lauper M, Kr.henbühl L. A Nation' s experience of bleeding complications during laparoscopy. Am J Surg 2000;180(1):73-7.
Opitz I, Gantert W, Giger U, Kocher T, Krahenbühl L. Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database. Langenbecks Arch Surg 2005;390(2):128-33.
Suuronen S, Kivivuorii A, Tuimala J, Paajanen H. Bleeding complications in cholecystectomy: a register study of over 22 000 cholecystectomies in Finland. BMC Surg 2015;15:97.
Thomson PM, Ross J, Mukherjee S, Mohammadi B. Are Routine Blood Group and Save Samples Needed for Laparoscopic Day Case Surgery? World J Surg 2016;40(6):1295-8.
Hack-Adams N, King N, Ahuja M, M Higgs S. Optimising the Pre-Operative Investigative Work Up for Elective Surgical Patients. BMJ Qual Improv Rep 2015;4(1):u206272.
Quinn M, Suttie S, Li A, Ravindran R. Are blood group and save samples needed for cholecystectomy? Surg Endosc 2011;25(8):2505-8.
Ghirardo SF, Mohan I, Gomensoro A, Chorost MI. Routine preoperative typing and screening: a safeguard or a misuse of resources. JSLS 2010;14(3):395-8.
Usal H, Nabagiez J, Sayad P, Ferzli GS. Cost effectiveness of routine type and screen testing before laparoscopic cholecystectomy. Surg Endosc 1999;13(2):146-7.
Lin JS, Chen YJ, Tzeng CH, Lyou JY, Lee CH. Revisiting of preoperative blood ordering policy - a single institute's experience in Taiwan. J Chin Med Assoc 2006;69(11):507-11.
Hamza N, Pereira M, Gilliam A. Routine group and save is unnecessary on the day of surgery for elective laparoscopic cholecystectomy. Bull Royal Coll Surg Engl 2015;97(6):E1-4.
Royal College of Obstetricians and Gynaecologists. Presenting information on risk. Clinical Governance Advice No. 7. London; 2008. [Internet]. [cited 2016 May 18]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/clinical-governance-advice/cga7-15072010.pdf
Calman KC, Royston GH. Risk language and dialects. BMJ 1997;315(7113):939-42.
Reeves B, Emberton M, Thoms G. Preoperative Tests: the use of routine preoperative tests for elective surgery. NHS 2003. [Internet]. [cited 2016 May18]. Available from: file:///C:/Users/Wali%20Muhammad/Downloads/29094.pdf
Fischer SP. Cost-effective Preoperative Evaluation and Testing. Chest 1999;115(5 Suppl):S96-100.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
